I’ve been struggling with where to take this theme – how to bring things to a close, in some grand philosophical finale. Those of you who frequent this space on a regular basis will notice that I have slipped a few days in my “weekly” post. That’s because I had proverbial writers’ block.

All of us are, to one degree or another, both distinguishable and indistinguishable from “Normal.” If we were all clones of some idealized template, cookie-cutter fashion, life would be very dull. If we were all equally matched, there would be no reason to engage in sports (the outcome would always be a tie score). If we were interchangeable it wouldn’t matter where we went to school (all professors being equally competent) or who we married (other than gender preference). But of course life isn’t like that, and we all do differ from one another. Even “identical” twins have slightly different sets of mitochondrial DNA. The real key is: Which differences give us a competitive advantage, or put us at a competitive disadvantage? A lot of engineers and computer programmers have mild (or, not so mild) atypicality. The same cognitive structures that enable Temple Grandin to do Computer Assisted Design in her head also give rise to her autism. A lot of concert musicians have both ASD and perfect pitch. And so on. ASD gives and takes away, at the same time. Read the rest of this entry »

“Indistinguishable from normal”

When I was in Indianapolis last week to address the annual meeting of the Autism Society of America, I had breakfast with one of the leaders in the field of Applied Behavior Analysis. As we were chatting about the benefits and the limits of ABA, he made a stunningly obvious (but seldom mentioned) observation: “Lovaas never promised that he could make kids with autism normal, only that he could make them ‘indistinguishable from normal’.” Let that sink in a bit.

Nearly 100 years ago, when my late father-in-law went to medical school, diabetes was a rapidly fatal disease. The entry on diabetes in his textbook of internal medicine is only half a page long, describing the acute onset, rapidly downhill course, and universally fatal outcome. Then, in 1923, two Canadian researchers, Frederick Banting and Charles Best, discovered and pioneered the use of insulin. All at once, diabetes became a treatable condition. Treatment, however, was arduous. When I was a medical student (in the 1960’s and 70s), treating a patient with diabetes involved repeated injections with insulin. And there were myriad forms of insulin: reglar, lente, ultra-lente, each with a different duration of action. We were trying to replicate the secretory function of the human pancreas, with limited success. In 1963, Arnold Kadish created the first insulin pump – it was the size of a backpack. In 1973 the prolific inventor Dean Kamen designed the first commercially successful (and considerably smaller) pump. Today, the mechanical aspects of insulin delivery have been married to real-time monitoring of the patient’s blood sugar level via on-board sensors and a computer chip, enabling the pump to respond to the patient’s blood sugar levels in real time. We are coming closer and closer to replicating the behavior of the human pancreas, and to all outward appearances the patient appears normal. No backpack, no repeated needle sticks, no episodes of hypoglycemia or glycosuria with trips to the bathroom. But at the end of the day, the patient still has diabetes. Read the rest of this entry »